Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A72818 | CA |
NPI | 1033211685 |
---|---|
Provider Name | Dr. Julian J. Nicholas |
First Address | San Diego, CA 92129-4532 |
Second Address | Yuma, AZ 85364-7170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A728180 | (05) | CA |
110218178 | RAILROAD MEDICARE (01) | |
B179 | CHAMPUS (01) | |
F675 | CHAMPUS (01) | |
H03112 | (02) | CA |